Vuity: The eye drop that could replace your reading glasses

About a year ago, the U.S. Food and Drug Administration authorized the first eye drop that could be used to improve the vision of people with a condition called presbyopia — the term doctors use for age-related farsightedness, or difficulty seeing things close-up. The condition affects up to half of all Americans.

Called Vuity, the eye drops are manufactured by California-based pharmaceutical company Allergan and are available by prescription. Clinical trials involving 750 people between the ages of 40 and 55 years found that a single drop in each eye improved near and intermediate vision for up to six hours while maintaining distance vision.

For people who loathe the reading glasses that rest at the tip of their noses, the idea of vision-correcting eye drops seemed revolutionary.

No serious adverse events were reported in the clinical trials. The most common side effects reported were headache and eye redness, which affected fewer than 5% of patients.

The Free Press spoke with Dr. Christopher Hood, a clinical associate professor of ophthalmology at the University of Michigan and the medical director of the cornea clinic at the Kellogg Eye Center, to share with readers how Vuity works, who is a candidate for the eye drops, who shouldn't use them, and more.

The following is a lightly edited transcript of the conversation:

Can you explain how the Vuity eye drops work?

There's this thing called presbyopia, which is a fancy word for what everybody has happen to their eyes when they get into their 40s.

The lens of your eye can't give you zooming-in power anymore, and that necessitates the need for reading glasses. So every human on Earth has this happen to them. In fact, the lens becomes less and less able to zoom in from the day you were born, really, but it's not significant until you're in your 40s, when you can't see the small print that we have on so many of our modern devices.

So, if you have perfect distance vision, you just wear reading glasses to help with that. And if you have corrected distance vision, then you have to have the bifocal at the bottom part to give you that near vision up close. It's a huge problem.

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Vuity is a relatively new drop that actually is a repurposed, reformulated old medication. It's called pilocarpine. It was reformulated slightly into a dilute concentration to be used for the effect of giving increased near vision.

It does so by basically constricting the pupil. It gives you a so-called pinhole effect, an enhanced depth of focus when you have a small pupil aperture or pupil opening. It's not a new idea. It was just reformulated for that purpose.

How was pilocarpine used before it was reformulated to make Vuity?

It originally was used as a glaucoma drop, which worked by constricting the pupil and sort of opening up the drainage network of the eye to lower eye pressures.

Now, it's hardly ever used for that purpose because we have much better drops with much less side effects than that original pilocarpine medication.

What are the side effects?

It can cause a headache around the eye by constricting the pupil. It can cause tearing, redness and irritation of the eye. Because the pupil can't dilate with this medication, it causes a little bit of decreased night vision.

It also increases the risk — and this is a very, very serious side effect — of retinal tears and retinal detachment.

Tell us more about the risk of retinal tears or detachment.

The retina is the back surface of the eye that is kind of like the film of the eye if it was a camera.

When this drop works, the constricting pupil pulls a little bit on the vitreous, which is a jelly that fills the eye and is usually firmly attached to the retina. That can sometimes tear the retina.

It's a rare side effect, but this is now being reported with the use of Vuity drops, and it's definitely something that's been getting some more press recently because for young, healthy patients it's a very serious side effect of this medication.

How much does Vuity cost?

These eye drops generally are not covered by insurance because it's considered a cosmetic medication, so to speak. It will vary by pharmacy, but it's probably $75 to $100 a month.

(A search of GoodRx found that estimate to be about right. The lowest listed price was $79.61, and the average was $90.57.)

Who is a good candidate for Vuity and who shouldn't use the drops?

A good candidate will be someone who has developed a need for reading glasses, typically someone in their mid-40s to typically mid-50s. Beyond that age, it's not going to give that much effect. You're a good candidate if you have young, healthy eyes.

Someone who's not a good candidate is anybody who has any retinal pathology or any high risk for retinal detachments. That would include things like a high level of nearsightedness, a thin retina, which can be diagnosed on a retinal exam, a history of retinal tears or even a family history of a retinal detachment.

Who can prescribe Vuity drops?

The vast majority of prescribing probably is done by optometrists because optometrists do screening eye exams and fit for glasses and contacts.

Ophthalmologists, who are medical doctors, generally treat diseases of the eye. Personally, as a cornea specialist within ophthalmology, I see very, very few patients who are candidates for this because I don't see healthy patients, especially healthy young patients.

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The general prescribing is going to be by optometrists and they are licensed to prescribe this. They do have the training to do a thorough eye exam. My opinion is that patients should have a complete dilated eye exam to look for any retinal pathology or any risk factors prior to being prescribed this eye drop.

And most specifically, doctors should also be counseling patients about the symptoms of retinal detachments and tears as well as other side effects of the medication so that they can be aware and call right away. Prompt treatment is so crucial to treating these things.

What happens if someone has a retinal detachment after using these eye drops?

It can be treated. The earlier, the better generally, and that's treated by a retina specialist within ophthalmology. Basically, prompt treatment would involve doing surgery or using a laser to reattach the retina. It is crucial to save the person's vision.

Interestingly, this complication was not discovered in the clinical trials by the company, which included close to 800 patients. This is a relatively rare side effect and their patient population was probably not at risk for this by design. But now that this is being used out in the real world, it has been reported.

In fact, a few of my colleagues at the Kellogg Eye Center have specifically reported on this as a risk. They've had two patients that have had retinal detachments that they had to repair. They've published on this in the peer-reviewed literature.

In addition, one of my colleagues has written up guidelines that were released by the American Society of Cataract and Refractive Surgery as kind of a warning of what should be discussed with patients prior to starting this eye drop.

Is there anything else you'd like readers to know?

This is a very, very common and pervasive issue that we need better treatments for. Vuity is not, by any means, an end-all, be-all treatment, but it's good that we're progressing in terms of discovering and working toward new treatments for presbyopia.

There's lots and lots of research going on with much more novel mechanisms — drops and otherwise — even with procedures to try to improve our near-vision functioning.

This is an eye drop that has side effects and risks. It could be beneficial for some patients, but I think it's important that they understand the risks before they start using it.

This is one step forward, but it's not a cure, and we need better treatments. That's the bottom line.

Contact Kristen Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus. Subscribe to the Free Press.

This article originally appeared on Detroit Free Press: Vuity eye drops: How it works, cost, side effects, risks